How Banner Health Network is managing interoperability with 30-plus EHRs

A new partnership with Holon Health enables real-time push of key patient information to network providers, regardless of their IT system, cluing them in to data they need to tackle care variation across the ACO.

Banner Health Network, with 5,000 affiliated physicians and 15 hospitals in the Phoenix area, is large and complex. Its accountable care and population health management efforts require lots of high quality data and a keen focus on closing gaps in care. But that's something of a challenge when those physicians are using more than 30 different electronic health records.

"Thirty-two, I think is the number," said David Coe, vice president of data management, analytics and population health technology at Banner Health. "So you could imagine doing point to point interfaces to each one of those individual EHR systems."

So BHN has recently tried a new approach to interoperability, partnering with Atlanta-based Holon for its CollaborNet platform, which Coe said connects physicians across the organization with necessary data to improve care coordination and pop health, enabling the jointly owned Banner|Aetna organization to make good on the the promise of value-based care, officials said.

"Holon has the ability to gather information from the EHRs of affiliated providers. This will allow us to universally push insights to providers, and have a simplified and comprehensive data set to analyze when looking at the overall health of the population," said Tom Grote, CEO at Banner|Aetna. "Now, we can see opportunities to refine care delivery or coding, thereby improving our ability to lower costs for employers and members, and to improve member outcomes."

The tool works as an add-on to a practice's EHRs. When a physician or other member of the care team opens a patient chart, the technology is able to detect relevant context and show gaps in care based on Banner claims data. This enables better care for the patient, better efficiency for the health network and a better experience for clinicians, said Coe, as workflow is streamlined and extra clicking is eliminate, freeing up time with patients.

A "light touch" for clinical alerts

"For us, this is a tool for accountable care: Interoperability around a certain use case, where you have providers who are not employed but instead are affiliated and independent you want to stay independent," Coe explained. "We need to be in their lives, but in a light-touch way that helps them manage our populations effectively without having to go and try to boil the ocean with every other use case."

For Banner Health Network to be effective as an ACO and clinically-integrated network, he said, "we recognized that we really have to be able to engage with providers in a way that fits within their workflow and in a way that sends data when they need it – not not just through a portal, not just retrospective or backward-looking, but in that moment when they're seeing somebody: one of our members, one of our patients," he said.

The upshot is that the Holon tool has helped it make the most of Banner's own data, and its existing IT infrastructure: "We've been able to take our Cerner HealtheIntent platform (and) use it to generate registries" to find gaps in care, he said.

"We have a pretty rich dataset with claims clinical information. But we also recognize we're doing a lot to enrich that data set and then turn it into actionable information. So it's really not enough just to say let's have everybody look at a portal and look backwards and do something administratively, when there's a pretty remarkable clinical opportunity."

Banner Health Network had "struggled for a number of years to work in different modalities to bring data closer to the point of care," Coe explained. "But we always ended up kind of one step away from that moment where the member is in the exam room with the provider at that moment when care is being provided."

Early results and risk adjustment opportunities

The promised ability to help bring that enriched data to far-flung providers across the network, irrespective of which EHR they use, was obviously intriguing, he said.

Those are big promises, of course. And Coe said his first response to the vendor was: "Prove it." So the ACO tried a proof of concept with the startup and "one of the more significant EHR vendors that's present in our ecosystem."

"In a few weeks," he said, "they were able to show me how they could gain the context to know who is in the exam room as the chart was being opened. And then soon they showed me how I would be able to satisfy my gaps in care, specific ACO and HEDIS and Star metrics."

The software gets installed on a desktop in the practice and, rather than interfacing with the EHR, it sits next to it and waits for a chart to open.

"It doesn't do anything if this chart opens up and it's not a member, or it doesn't do anything if a chart opens up and there's nothing to say about that member," said Coe. "Instead it waits for a member to show up, for the chart to open up in that exam room.

"Then what it does is it pops up as a non-intrusive alert that alerts the provider or support staff that this is a member you're probably at risk for or have some value based arrangement for," he added. "It says there's some gaps in care, there might be a risk adjustment opportunity."

The provider "can simply ignore it if they choose to," said Coe. "We don't want to be prescriptive about that. Or they can click on the alert to find out more." Doing that will open a sidebar, he explained: "'Here are some gaps in care we see for this person. They have something so we're looking for it to be addressed."

The alerts are based on Banner's own data, on the "insights that we have developed within our core system," he said. "We've made tons of investment in clinical decision support tools and registries and reporting tools. Holon just carries the message – they're are the nervous system to our brains."

The benefits to that approach are numerous, said Coe. "It saves you retrospective portal work later. So what used to be an administrative activity is now a clinical activity: The provider is actually taking a course of action that they're trained to do, working at the top of their license in their clinical workflow without interruption, and dealing with alerts in a natural way."

Banner recognizes the toll of physician burnout, and the excesses of administrative chores and too-many-clicks.

"There is provider fatigue out there. There's alert fatigue that's happening. There is an administrative burden that's just just very real,” Coe said. “So being able to solve for that has been pretty great."